HEALTH AND RISK ASSESSMENT



HEALTH AND RISK ASSESSMENTFOR EMPLOYEE SAFETY IN THE CARE AND USE OF ANIMALSUniversity of South Florida, Research Integrity & Compliance; email IACUC@usf.edu or fax (813) 974-7091Completed forms should be saved as a PDF and uploaded into the ARC system viewable at: of publications referred to in this form are available on the Web at 1. Occupational health and safety principles require that employees know the hazards associated with their work, understand how these hazards are controlled, utilize safe practices, and use protective supplies and equipment. 2. The Public Health Service Policy on Humane Care and Use of Laboratory Animals requires institutions to provide occupational health-care services to employees who work with animals.3. This is not a requirement to provide specific health-care services to all employees with animal contact. On the contrary, the report of the Committee on Occupational Safety and Health in Research Animal Facilities (NRC, 1997) emphasizes that a risk assessment be a prerequisite in selecting appropriate health-care services for each employee. 4. This should be a collaborative assessment of risk which includes the principal investigator, research employee, health and safety officers, veterinarian, compliance officer, and animal care staff. 5. As a way of initiating and documenting this assessment, each employee working with animals must complete this health and risk assessment document.1. PERSONNEL INFORMATION. 04826000NameE-mail Phone04064000Principal Investigator’s NameDepartmentPhoneInstitutional Affiliation: FORMCHECKBOX USF FORMCHECKBOX Moffitt FORMCHECKBOX JAHVAH FORMCHECKBOX Unaffiliated___________________ Institutional Status: FORMCHECKBOX Employee FORMCHECKBOX Student FORMCHECKBOX Volunteer FORMCHECKBOX Other___________________2. PROTOCOL & ANIMAL FACILITY RELATED EXPOSURES.Indicate with a check below that you: FORMCHECKBOX Have reviewed the webpage entitled “Occupational Health & Safety in the Care and Use of Animals” viewable at FORMCHECKBOX Have considered the protocols in which you will be involved, the species to be used, risk factors associated with the use of each species, and any unique hazards associated with the animal care and use aspects of each protocol. FORMCHECKBOX Are aware that rodents (i.e., mice & rats) are the most prevalent laboratory animal species housed and used in most animal facilities. FORMCHECKBOX Are aware that furred animals produce human allergens, including α2μ-globulins present in the urine of rodents and the saliva and dander of cats, which can remain airborne for extended periods and penetrate lower airways, resulting in allergic symptoms in at risk personnel, including respiratory symptoms, a rash or hives, or anaphylaxis. FORMCHECKBOX Are aware that even the use of animal tissue poses a risk to the health of researchers through the transfer of disease (e.g., brucellosis, leptospirosis, listeriosis).?3. INFECTIOUS AND BIOHAZARDOUS AGENTS.Do these protocols involve animals experimentally or naturally infected with an infectious agent known to cause disease in healthy adult humans, (Agents in Risk Group RG2, RG3, or RG4, of Appendix B of NIH Guidelines for Research Involving Recombinant DNA Molecules (NIH, 2009), or an agent in the agent summary statements of Biosafety in Microbiological and Biomedical Laboratories (CDC-NIH, 2009), or an agent known to cause disease in animals, which is infectious to human cells (Agents in Appendix B-V of NIH Guidelines for Research Involving Recombinant DNA Molecules (NIH, 2009), or a zoonotic agent in the agent summary statements of Occupational Health and Safety in the Care and Use of Research Animals (NRC, 1997)?38989004572000 FORMCHECKBOX No:Proceed to Item #4. FORMCHECKBOX Yes: This infectious agent(s) is: 12573004254500Of NIH Risk Group: Occupational health care services are required for employees engaged in animal research involving infectious agents that need biosafety level 3 containment. If using Human Blood or Blood products : please note you must complete Blood Borne Pathogen (BBP) training To take the BBP required training you will need to go to Learn at: then find Safety: Back to Basics, then choose OSHA Blood borne Pathogen (BBP) Education AND Preventing Occupational Exposure to blood borne Pathogens. They both have a post-test. You can print off your completion status after the tests to submit as verification of having taken the training. Send your verification to mha@health.usf.edu along with your forms.4. SAFETY PROCEDURES.Can you suggest any additional precautions, containment practices or facilities, protective devices, disposal methods, decontamination procedures, or other safety procedures to protect personnel, and prevent accidental animal exposure to hazardous materials? (You may find that Biosafety in Microbiological and Biomedical Laboratories (CDC-NIH, 2009), NIH Guidelines for Research Involving Recombinant DNA Molecules (NIH, 2009), Occupational Health and Safety in the Care and Use of Research Animals (NRC, 1997), and MSDS are helpful references). Notify IACUC & Safety Committees c/o Research Integrity and Compliance, 974-7106.33020008509000 FORMCHECKBOX No:Proceed to Item #5. FORMCHECKBOX Yes: Please indicate:5. SPECIAL CONSIDERATIONS.Do these protocols involve unvaccinated or uncharacterized carnivores, pregnant sheep, goats, cattle, or nonhuman primates? FORMCHECKBOX No:Proceed to Item #6. FORMCHECKBOX Yes:Occupational health care services are required for employees engaged inresearch involving unvaccinated or uncharacterized carnivores, pregnant sheep, goats, or nonhuman primates. If so, please contact your health care provider or one of the following officesUSF employees contact Medical Health Administration at 974-3163 email: mha@health.usf.eduMoffitt employees contact Occupational Health Department at 745-4276 email: JoAnn.Griggs@VAH employees contact Employee Health floor 6N room #650 972-2000.6. CLINICAL CONDITION.Should an occupational health care professional be made aware of any previously undeclared, existing, or possible future conditions which could affect your ability to perform your research duties without risk of substantial harm, such as, but not limited to, a personal or family history of allergy (e.g., seasonal rhinitis, hay fever, eczema, hives, latex allergy, or the need to wear respiratory protection/ mask), asthma symptoms (e.g., coughing, wheezing, chest tightness, or shortness of breath), chronic skin condition or irritation, tuberculosis, spina bifida, diabetes, epilepsy, immunodeficiency, hearing loss, or medications which compromise immunocompetence? FORMCHECKBOX No:Proceed to Item #7. FORMCHECKBOX Yes:If so, please complete the Health History Assessment Form and contact your health care provider or one of the following offices.USF employees contact Medical Health Administration at 974-3163 email: mha@health.usf.eduMoffitt employees contact Occupational Health Department at 745-4276 email: JoAnn.Griggs@VAH employees contact Employee Health floor 6N room #650 972-2000.7. TETANUS.Puncture wounds from sharps and animal bites are an intermittent, but possible hazard. Animal bites, even from rodents, can develop severe complications. All personnel working with animals must keep their tetanus immunization status current. The Public Health Service Advisory Committee on Immunization Practices (ACIP 2010) recommends administration of vaccine for tetanus every ten years. Please consider contacting your health care provider or one of the following offices if you are unaware of your tetanus immunization status, or if it is outdated.USF employees contact Medical Health Administration at 974-3163 email: mha@health.usf.eduMoffitt employees contact Occupational Health Department at 745-4276 email: JoAnn.Griggs@VAH employees contact Employee Health floor 6N room #650 972-2000.8.? HEPATITIS B.Employees, Students, Contract Personnel, and Volunteers identified at risk for exposure to human blood and/or body fluids in the normal course of their job duties must meet educational requirements and participate in the Hepatitis B vaccination program.? The Hepatitis B vaccination series is available at no cost after training and within 10 days of initial assignment to “at risk” personnel.? Does this protocol involve the use of or contact with any of the following?Human bloodUnfixed tissue/organ from human (e.g., primary patient-derived tumor resections or cells)Cells or tissue cultures, organ cultures, culture media that may contain blood-borne pathogensExperimental animals infected with blood-borne pathogensHuman serological and biological reagents (antibody, antigen or antisera)Immunodeficient or genetically modified animals (GMAs) susceptible to or shedding human pathogens FORMCHECKBOX NoThese protocols do not involve the use of?human tissues or blood. FORMCHECKBOX YesIf so, please contact your health care provider or one of the following officesUSF employees contact Medical Health Administration at 974-3163 email: mha@health.usf.eduMoffitt employees contact Occupational Health Department at 745-4276 email: JoAnn.Griggs@ VAH employees contact Employee Health floor 6N room #650 972-2000.9. CERTIFICATION.I have discussed the potential risks and hazards associated with my involvement in animal protocols with the principal investigator of those protocols. I understand that a Supervisor’s Incident/Injury Report for must be completed after all accidents, injuries, or suspected hazardous exposures involving animals, or which occur in animal facilities. I understand that recommendations can be made regarding this health & safety program c/o Research Integrity & Compliance at iacuc@usf.edu . I assure that the conduct of protocols and all animal care and use will be in accordance with the IACUC’s Principles & Procedures of Animal Care and Use, as well as the principles and guidelines referenced above. This description is complete and accurate. I certify I am as adequately trained and experienced to conduct my duties._____________________________________________ _______________________________________________Signature of EmployeeDate Signature of Principal Investigator Date ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download